Provider Demographics
NPI:1205453636
Name:ICHIMURA, ERIN S (PT, DPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:S
Last Name:ICHIMURA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:S
Other - Last Name:ICHIMURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:95-1005 KUAULI ST APT 147
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-4938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR STE 207
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3968
Practice Address - Country:US
Practice Address - Phone:808-487-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist